HomeMy Public PortalAbout9617 LAS TUNAS DR_Sewer__ 7BA842D
ceeoe s•s° APPLICATION FOR PERMIT 7
� COUNTY OF LOS ANGELES1
SEWER-SEWAGE DISPOSAL
'DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -
ADDRESS
JOHN A. LAMBIE. County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
F
DESCRIPTION LOT NO. f X Cl' f-' <� ! OWNER
BLOCK TRACT MAIL
ADDRESS
/' N0.OF BLDGS.
SIZE OF LOT
NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUPBK MAP PG PRO ESSED BY
CONTRACTOR - I
ADDRESS •_ A CONNECTION DATA
CITYTEL.NO. ' p� ? ? STATION 1p,� �� DEPTH
REGISTRATION NO. ❑ COUNTY STATE
MANHOLE REFERENCE -T ( �'
1-- i LOWER J
No. DESCRIPTION OF WORK FEE —
i HOUSE SEWER CONNECTING TO -/
PUBLIC SEWER @ $3.00 -.� LITYPE OF CONNECTI, __-, LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. \ M.L.TO P.L. --j
ITS AND/OR DRAINFIELD @ $3.00 j
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.. CESSPOOL, DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO 7 P.C.NO.
_ PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALT , REPAIR O R ABANDON SYSTEM HOUSE @ $I OO STATE ENCROACHMENT
SEWER
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT DZ.Q-'tom BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
LDESCRRIBED
COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
AND SEWERS. SEWAGE DISPOSAL SYSTEM
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
IA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKSSEEP. PIT(S) ❑ CESSPOOLSEITTEE
®f VALIDATIOPV---y ROBERT A. WOOD
CK. H,o. ��CAS�Hy SUPERVISING MECHANICAL ENGINEER